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        <h2>Join the <span class="titlePop zi">SECRET DOLLS</span> <span class="zi">Authorized Dealer</span> </span> <nobr>Program Today!</nobr> </h2>
        <p>"At  SECRET DOLLS, our mission is to do whatever it takes to help our Dealers succeed. Being the #1 name in sex dolls service means making the investments in training, product, and support that our Dealers need to grow their businesses. That's why so many of the industry's most successful Dealers choose  SECRET DOLLS."</p>
        <p>Email:  <a href="mailto:cs@secret-doll.com"  >cs@secret-doll.com</a></p>




        <p class="signature">- Max, President - Dealer Business</p>
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        <form action="" class="form-inline" id="signUpForm" method="post">    <div class="clearfix">

            <div class="col-xs-12 col-sm-6 left">
                <div class="form-group">
                    <label for="firstName">First Name*</label><br>
                    <input class="form-control" data-val="true" data-val-length="First Name must be under 50 characters." data-val-length-max="50" data-val-required="First Name is required." id="firstName" maxlength="50" name="first_name" placeholder="" type="text" value="">
                    <span class="error"><span class="field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span></span>
                </div>

                <div class="form-group">
                    <label for="lastName">Last Name*</label><br>
                    <input class="form-control" data-val="true" data-val-length="Last Name must be under 50 characters." data-val-length-max="50" data-val-required="Last Name is required." id="lastName" maxlength="50" name="last_name" placeholder="" type="text" value="">
                    <span class="error"><span class="field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span></span>
                </div>

                <div class="form-group">
                    <label for="emailAddress">Email Address*</label><br>
                    <input class="form-control" data-val="true" data-val-length="Email must be under 150 characters." data-val-length-max="150" data-val-regex="Email is not valid." data-val-regex-pattern="^(([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})+([;.](([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})+)*$" data-val-required="Email is required." id="emailAddress" maxlength="150" name="email" placeholder="" type="email" value="">
                    <span class="error"><span class="field-validation-valid" data-valmsg-for="Email" data-valmsg-replace="true"></span></span>
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                <div class="form-group">
                    <label for="company">Company or Individual *</label><br>
                    <input class="form-control" data-val="true" data-val-length="Company Name must be under 100 characters." data-val-length-max="100" data-val-regex="Business Name is not valid." data-val-regex-pattern="^[0-9a-zA-Z\s]*$" data-val-required="Company Name is required." id="company" maxlength="100" name="company" placeholder="" type="text" value="">
                    <span class="error"><span class="field-validation-valid" data-valmsg-for="BusinessName" data-valmsg-replace="true"></span></span>
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                <div class="form-group jobTitleBx">
                    <label for="jobTitle">Job Title*</label><br>
                    <input class="form-control" data-val="true" data-val-length="Job Title must be under 100 characters." data-val-length-max="100" data-val-required="Job Title is required." id="jobTitle" name="job_title" placeholder="" type="text" value="">
                    <span class="error"><span class="field-validation-valid" data-valmsg-for="Title" data-valmsg-replace="true"></span></span>
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                <div class="col-md-4 col-xs-12 nopad">
                    <div class="form-group zipBx" style="width:90%;">
                        <label for="phone">Phone*</label><br>
                        <input class="form-control" id="tel"   name="tel" placeholder="" type="zip" value="">

                    </div>
                </div>

                <div class="col-md-4 col-xs-12 nopad">
                    <div class="form-group stateBx">

                        <label for="state">State*</label><br>
                        <select class="form-control" id="state" name="state" data-val="true" data-val-required="State is required.">
                            <option value="">Select</option>
                            <option value="CAN">Canada</option>
                            <option value="PR">Puerto Rico</option>
                            <optgroup label="US States">
                                <option value="AL">Alabama</option>
                                <option value="AK">Alaska</option>
                                <option value="AZ">Arizona</option>
                                <option value="AR">Arkansas</option>
                                <option value="CA">California</option>
                                <option value="CO">Colorado</option>
                                <option value="CT">Connecticut</option>
                                <option value="DE">Delaware</option>
                                <option value="FL">Florida</option>
                                <option value="GA">Georgia</option>
                                <option value="HI">Hawaii</option>
                                <option value="ID">Idaho</option>
                                <option value="IL">Illinois</option>
                                <option value="IN">Indiana</option>
                                <option value="IA">Iowa</option>
                                <option value="KS">Kansas</option>
                                <option value="KY">Kentucky</option>
                                <option value="LA">Louisiana</option>
                                <option value="ME">Maine</option>
                                <option value="MD">Maryland</option>
                                <option value="MA">Massachusetts</option>
                                <option value="MI">Michigan</option>
                                <option value="MN">Minnesota</option>
                                <option value="MS">Mississippi</option>
                                <option value="MO">Missouri</option>
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                                <option value="NE">Nebraska</option>
                                <option value="NV">Nevada</option>
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                                <option value="NJ">New Jersey</option>
                                <option value="NM">New Mexico</option>
                                <option value="NY">New York</option>
                                <option value="NC">North Carolina</option>
                                <option value="ND">North Dakota</option>
                                <option value="OH">Ohio</option>
                                <option value="OK">Oklahoma</option>
                                <option value="OR">Oregon</option>
                                <option value="PA">Pennsylvania</option>
                                <option value="RI">Rhode Island</option>
                                <option value="SC">South Carolina</option>
                                <option value="SD">South Dakota</option>
                                <option value="TN">Tennessee</option>
                                <option value="TX">Texas</option>
                                <option value="UT">Utah</option>
                                <option value="VT">Vermont</option>
                                <option value="VA">Virginia</option>
                                <option value="WA">Washington</option>
                                <option value="WV">West Virginia</option>
                                <option value="WI">Wisconsin</option>
                                <option value="WY">Wyoming</option>
                            </optgroup>
                        </select>

                        <span class="error"><span class="field-validation-valid" data-valmsg-for="State" data-valmsg-replace="true"></span></span>
                    </div>
                </div>
                <div class="col-md-4  col-xs-12 nopad">
                    <div class="form-group zipBx">
                        <label for="zip">Zip Code*</label><br>
                        <input class="form-control" data-val="true" data-val-length="Zip must be 6 characters or under." data-val-length-max="6" data-val-required="Zip is required." id="zip_code" maxlength="6" name="zip_code" placeholder="" type="zip" value="">
                        <span class="error"><span class="field-validation-valid" data-valmsg-for="Zip" data-valmsg-replace="true"></span></span>
                    </div>
                </div>
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                <div style="margin-top:5px;">
                    <label class="checkbox title label-inline">Do you have more than $5,000 capital to invest in your business?*	&nbsp;  &nbsp;  &nbsp; </label>
                    <label class="checkbox">
                        <span><input class="short" data-val="true" data-val-required="Please select an answer above." id="is_invest" name="is_invest" type="radio" value="Yes"> Yes</span>
                    </label>
                    <label class="checkbox">
                        <span><input class="short" id="is_invest" name="is_invest" type="radio" value="No"> No</span>
                    </label>
                    <span class="error capital-invest"><span class="field-validation-valid" data-valmsg-for="HaveCapitalToInvest" data-valmsg-replace="true"></span></span>
                </div>



                <div class="checkbox" style="margin-top:25px !important;">
                    <label >Please select all that apply*</label><br ><br >
                    <span id="errorCb" class="error"></span>

                    <label class="checkbox longblock">
                        <span><input class="short" name="join_select[]" type="checkbox" value="1" > interested in becoming an exclusive agent in state</span>
                    </label>
                    <label class="checkbox longblock">
                        <span><input class="short" name="join_select[]" type="checkbox" value="2"> Own your own sales website</span>
                    </label>
                    <label class="checkbox longblock">
                        <span><input class="short" name="join_select[]" type="checkbox" value="3"> Own adult store</span>
                    </label>
                    <label class="checkbox longblock">
                        <span><input class="short" name="join_select[]" type="checkbox" value="4"> Currently in related industries</span>
                    </label>
                    <label class="checkbox longblock">
                        <span><input class="short" name="join_select[]" type="checkbox" value="5"> Interested in building a doll online store</span>
                    </label>
                    <label class="checkbox longblock">
                        <span><input class="short" name="join_select[]" type="checkbox" value="6"> Interested in becoming a part-time agent</span>
                    </label>
                </div>




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                <label class="reqfltxt">*Required Fields</label>
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